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Journal of Mental Health

ISSN: 0963-8237 (Print) 1360-0567 (Online) Journal homepage: http://www.tandfonline.com/loi/ijmh20

Non-deployment factors affecting psychologicalwellbeing in military personnel: literature review

Samantha K. Brooks & Neil Greenberg

To cite this article: Samantha K. Brooks & Neil Greenberg (2017): Non-deployment factorsaffecting psychological wellbeing in military personnel: literature review, Journal of MentalHealth, DOI: 10.1080/09638237.2016.1276536

To link to this article: http://dx.doi.org/10.1080/09638237.2016.1276536

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J Ment Health, Early Online: 1–11! 2017 Informa UK Limited, trading as Taylor & Francis Group. DOI: 10.1080/09638237.2016.1276536

REVIEW ARTICLE

Non-deployment factors affecting psychological wellbeing in militarypersonnel: literature review

Samantha K. Brooks and Neil Greenberg

King’s College London, King’s Centre for Military Health Research, Weston Education Centre, London, UK

Abstract

Background: Most military mental health research focuses on the impact of deployment-relatedstress; less is known about how everyday work-related factors affect wellbeing.Aims: This systematic narrative literature review aimed to identify non-deployment-relatedfactors contributing to the wellbeing of military personnel.Method: Electronic literature databases were searched and the findings of relevant studies wereused to explore non-deployment-related risk and resilience factors.Results: Fifty publications met the inclusion criteria. Determinants of non-deployment stresswere identified as: relationships with others (including leadership/supervisory support; socialsupport/cohesion; harassment/discrimination) and role-related stressors (role conflict; commit-ment and effort-reward imbalance; work overload/job demands; family-related issues/work-lifebalance; and other factors including control/autonomy, physical work environment andfinancial strain). Factors positively impacting wellbeing (such as exercise) were also identified.Conclusions: The literature suggests that non-deployment stressors present a significantoccupational health hazard in routine military environments and interpersonal relationships atwork are of fundamental importance. Findings suggest that in order to protect the wellbeing ofpersonnel and improve performance, military organisations should prioritise strengtheningrelationships between employees and their supervisors/colleagues. Recommendations foraddressing these stressors in British military personnel were developed.

Keywords

Military, leadership, management,organisational culture, social support

History

Received 13 June 2016Revised 23 August 2016Accepted 16 October 2016Published online 25 January 2017

Introduction

Within any workplace there are certain stressors which can

affect psychological wellbeing, job satisfaction and job

performance. (Bryson et al., 2014)

There has been much research on stress in the military,

though generally this tends to focus on stressors relating to

combat operations, such as traumatic exposure to death and

injuries, exhaustion and deprivation, and being exposed to

extreme climates. An international review of occupational

stressors in the military (Campbell & Nobel, 2009) identified

several categories of stressors. Though much of the review

focused on deployment-related stress, results also yielded

several categories of stressors applying to non-deployed

personnel, including work stressors (e.g. workload, role

ambiguity, poor leadership); social-interpersonal stressors

(e.g. acceptance, conflict, friendship); and family-related

stressors (e.g. separation).

It thus appears that non-deployment stress may be

substantial and important to consider. In light of the

completion of the withdrawal of forces from Afghanistan in

2014/15, there is a need to identify factors of stress beyond

those associated with being in a combat zone. Though non-

deployment stressors have received greater attention within

military research in recent years, there has to date been no

systematic review synthesising the various results.

Throughout this review, we use the term non-deployment

stress due to the intent to explore workplace stressors outside

of the operational environment. Our definition of non-

deployment stress is based on the Health and Safety

Executive (HSE, 2007) definition of workplace stress as the

adverse reaction which employees experience following

excessive pressures or demands at work. The HSE describes

six primary sources of work stress: demands (whether

employees can cope with the demands of their job), control

(the extent to which employees have a say in their work),

support (whether adequate support is received from col-

leagues), relationships (whether employees are subject to

negative behaviours e.g. bullying), role (the extent to which

employees understand their responsibilities) and change

(whether employees feel involved in organisational changes).

This review was exploratory in nature, and therefore

although there are several models of job stress we did not aim

to test any specific hypothesis, and instead aimed to simply

explore any and all non-deployment factors affecting the

psychological wellbeing or related organisational outcomes

Correspondence: Samantha K. Brooks, King’s College London, King’sCentre for Military Health Research, Weston Education Centre,Cutcombe Road, London SE5 9RJ, UK. Tel: 020 7848 0267. E-mail:samantha.k.brooks@kcl.ac.uk

(e.g. job satisfaction) of military personnel, with the goal of

developing recommendations for reducing non-deployment

stress. This paper is the first to our knowledge to systematically

review all of the literature in the area of non-deployment stress.

By presenting all of the current literature together, we aimed to

(1) identify any gaps in the literature or any limitations to the

current research and (2) use our identification of non-deploy-

ment stressors to make suggestions for how stress can be

reduced in routine military environments.

Method

Type of review

This systematic narrative review involved systematic search-

ing of literature followed by narrative analysis. This method

was chosen as the review was exploratory in nature (i.e.

aiming to explore the number of different factors associated

with military stress rather than testing any specific hypoth-

esis). The narrative format of analysis allows us to provide a

summarised overview of the broad range of topics covered.

Narrative reviews have become increasingly ‘systematic’ in

nature and are frequently used to review quantitative data

when studies are not similar enough to undergo meta-analysis

(Snilstveit et al., 2012). Narrative reviews can be strengthened

by incorporating elements of a systematic literature review

(Murphy, 2012), which we have done in this study i.e. the

search strategy, use of multiple databases, and standardised

data extraction process.

Selection of studies

Inclusion criteria were:

� Peer-reviewed primary studies;

� Reporting on non-deployment-related factors associated

with any aspect of psychological wellbeing or job

satisfaction in military personnel;

� English language;

� Published 2003–2013 (a time period of ten years was

chosen due to the volume of studies in this area);

� Quantitative studies (to allow us to identify factors which

showed statistically significant associations with out-

comes, or report whether there were inconsistencies in

the literature if some studies reported significant associ-

ations and others showed no associations);

� Scoring at least 75% on all sections of our quality

appraisal.

Conducting the review

This review forms part of a wider study on workplace stress in

high-risk occupational settings. Though this paper focuses

entirely on military literature, one search was undertaken to

cover both military and comparable high-risk occupations.

Therefore, search terms were separated into three compo-

nents: military terms (e.g. Army, Navy), other high-risk

occupation terms (e.g. police, fire fighter) and wellbeing-

related terms (e.g. stress, depression). One search using

military ‘‘AND’’ wellbeing-related terms was conducted, and

one search using civilian ‘‘AND’’ wellbeing-related terms.

Full search terms can be seen in Appendix I. Multiple

electronic databases were searched: the British Nursing Index;

Cochrane; EMBASE; Health Management Information

Consortium; MEDLINE; PsycINFO; Science Direct; and

Web of Science. Resulting citations were downloaded to

EndNote� software version X7 (Thomson Reuters, New

York, NY).

Article screening

Duplicate citations were removed. Titles of citations were

assessed and any clearly irrelevant to the study were removed.

The abstracts of those remaining were read, evaluated and full

texts of papers identified as potentially eligible for inclusion

were obtained. The reviewer read these papers in their

entirety and assessed eligibility according to inclusion

criteria. Reference lists of all included studies were also

hand-searched.

Data extraction and quality assessment

Details from relevant studies were extracted into spreadsheets

designed specifically for this review, with headings such as

‘‘country of study’’, ‘‘participant demographics’’, ‘‘measures

used’’ and ‘‘outcomes’’ (full data extraction table available

on request). Studies were assessed for quality in three

different areas: study design; data collection and method-

ology; and analysis and interpretation of results. Quality

assessment forms were designed for the study, informed by

existing tools such as the Effective Public Health Practice

Project’s Quality Assessment Tool for Quantitative studies

(EPHPP, 2009) and the British Medical Journal’s criteria

originally designed for assessing economic studies

(Drummond & Jefferson, 1996). This combination of assess-

ment tools was used to ensure a comprehensive quality

appraisal; the final appraisal tool can be seen in Appendix II.

Each study was given an overall score.

Synthesis of results

Thematic analysis was used to group predictors of wellbeing

(both positive and negative) into a typology, and the

‘‘themes’’ which emerged from the literature are presented

in this review. To be accepted as a theme, topics needed to be

identified by at least two studies. One reviewer (SKB) went

through the results of each paper, noting which stressors were

explored in each one, and these stressors were then coded into

appropriate ‘‘themes’’. Any uncertainties regarding the def-

inition of themes were discussed with another researcher

(NG) until consensus was reached. The coding of results into

themes was guided purely by the data itself and not by any of

the various categories of workplace stressors already

proposed by workplace stress models.

As we were interested in factors affecting both risk and

resilience, we included any studies reporting on stressors, risk

factors, mediators or moderators of stress, or protective

factors. As these terms clearly cannot be used inter-change-

ably, we report on them using the terminology used in the

original papers.

Results

As stated earlier, this report forms part of a wider review on

workplace stress in high-risk occupations thus the search

2 S. K. Brooks & N. Greenberg J Ment Health, Early Online: 1–11

strategy encompassed non-military literature also. 11,834

studies were initially found, of which 8295 related to the

military. After the various screening processes, 50 papers

were retained for data extraction (see Appendix III for details

of the full screening process). We note that this is a small

retention rate: however, this is a reflection of the very broad

search strategy that was used to avoid missing any potentially

relevant papers. A summary of the literature reviewed in

this study (including year of publication, country, design,

number of participants and military service) can be seen

in Table 1.

An overview of stressors identified is presented in Table 2.

Relationships with others

Leadership and supervisory support

Effective leadership was found to be important for wellbeing

in military organisations, likely due to the highly structured

environment. Aspects of leadership identified as particularly

beneficial included trustworthiness (Redman et al., 2011);

skills, knowledge and concern for morale and success

(Pflanz & Ogle, 2006); being ‘‘involved’’ rather than distant

and providing motivation, stimulation, clear expectations and

recognition (Bass et al., 2003); and providing regular

feedback (Mohd Bokti & Abu Talib, 2009). Perceived

supervisory support predicted occupational and psycho-

logical outcomes in the US military (Dupre & Day, 2007),

and stress and strain in the Royal Navy (UK) (Brasher et al.,

2010; Bridger et al., 2007, 2009), with better perceptions of

support associated with better outcomes. Leaders with

attachment-related anxiety were associated with subordin-

ates’ poor instrumental functioning, socio-emotional func-

tioning and mental health in the Israeli military (Davidovitz

et al., 2007).

Social support and cohesion

Social support, particularly from colleagues, was found to be

important. Unit cohesion (the unity or bonds between

employees in a team) was positively associated with overall

health in the US military (Mitchell et al., 2011) and job

satisfaction and stress in the US Army (Walsh et al., 2010).

Several US studies suggested unit cohesion and a strong sense

of ‘‘belongingness’’ were significant protective factors

against suicidal ideation (Bryan et al., 2013;

Langhinrichsen-Rohling et al., 2011; Mitchell et al., 2012).

Increased conflict with co-workers predicted stress and

depression in the US Air Force (Pflanz & Ogle, 2006) and

stress in Royal Navy submariners (Brasher et al., 2010). Low

peer support was associated with strain in the UK Navy

(Bridger et al., 2007); depression and post-traumatic stress

disorder (PTSD) in US Army personnel (Carter-Visscher

et al., 2010); PTSD, depression, stress and suicidal ideation in

the Canadian military (Mota et al., 2012; Nelson et al., 2011);

psychological distress (Rona et al., 2009) and PTSD, common

mental disorders and alcohol misuse (Harvey et al., 2011) in

UK personnel; and suicidal ideation in the Canadian military

(Nelson et al., 2011) and US Air Force (Langhinrichsen-

Rohling et al., 2011). Hatch et al. (2013), comparing UK

service personnel and those who left the service, found

service leavers reported less social participation outside work

and a general disengagement with military social contacts in

comparison to serving personnel, and were more likely to

report common mental disorders and PTSD. Conversely, high

support within the organisation was associated with better job

satisfaction and turnover intentions in the Canadian military

(Dupre & Day, 2007) and better self-rated health in the

Slovenian military (Selic et al., 2012). Social support was a

protective factor for psychological distress in US Air Force

personnel (Lemaire & Graham, 2011) and Marines (Hourani

et al., 2012).

Harassment and discrimination

Sexual harassment was associated with higher risk of turnover

in the US military personnel (Nye et al., 2010) and lower co-

worker satisfaction and more reported role limitations in the

US military (Settles et al., 2012). Perceived tokenism (e.g.

isolation, stereotyping) was associated with lower levels of

organisational commitment in US Army Captains (Karrasch,

2003).

Role-related stressors

Role conflict

Role conflict and lack of job clarity – i.e. lack of

understanding of what is expected of one in their workplace

or not understanding one’s responsibilities – also appeared to

be predictive of psychological and work-related outcomes.

Role conflict predicted strain in the Royal Navy (Bridger

et al., 2007); occupational stress in the Indian Navy (Pawar &

Rathod, 2007); physical and psychological health symptoms

in the Canadian military (Dupre & Day, 2007), and psycho-

logical distress in Australian Navy personnel (McDougall &

Drummond, 2010).

Commitment, over-commitment and effort-reward imbalance

Brasher et al. (2012) found that over-commitment and

difficulty disengaging from work predicted stress in Royal

Navy submariners. Bridger et al. (2011) found that the biggest

stressor for UK Naval personnel was inability to disengage

from work, implying over-commitment. Royal Navy person-

nel with chronic strain were more likely to perceive that

reward for high effort was lacking than those without chronic

strain, and more likely to be over-committed to their specific

work role but lack commitment to the service as a whole

(Bridger et al., 2009). Submariners with the highest stress

levels tended to be those who were over-committed to their

work roles, but lacked commitment to the Royal Navy as a

whole (Brasher et al., 2010). There were also positive findings

relating to commitment; for example, Meyer et al. (2013)

found that commitment mediated the relationship between

stress and both psychological and work-related outcomes in

the Canadian military.

Effort-reward imbalance was strongly associated with

mental disorders in Brazilian Army personnel (Martins &

Lopes, 2012, 2013). Conversely, appreciation at work was

positively associated with job satisfaction and negatively

associated with feelings of resentment in the Swiss military

(Stocker et al., 2010).

DOI: 10.1080/09638237.2016.1276536 Non-deployment predictors of wellbeing 3

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DOI: 10.1080/09638237.2016.1276536 Non-deployment predictors of wellbeing 5

Work (over) load and job demands

In one US study, 33% and 30% of Air Force personnel listed

‘‘work overload’’ and ‘‘long work hours’’ as their primary

sources of job stress, respectively (Pflanz & Ogle, 2006).

High role strain predicted decreased mental health in US Air

Force women (Hopkins-Chadwick & Ryan-Wenger, 2009).

Qualitative overload (that is, pressures of the job related to

responsibility and complexity of work rather than amount of

work) predicted poor work ability in the Netherlands Army

(Goedhard & Goedhard, 2005). Having too heavy a workload

and a quantity of work which could interfere with quality

predicted occupational stress in the Malaysian Navy (Mohd

Bokti & Abu Talib, 2009). The higher the workload, the

greater the strain in the UK Navy (Bridger et al., 2009) and

psychological distress in Australian Navy personnel

(McDougall & Drummond, 2010). However, in one study

workload was found to correlate positively with performance

in the US Army, whereas role overload (the perception of

individuals that their resources are overwhelmed) was not

correlated with performance (Thomas et al., 2005). Sanchez

et al. (2004) found the strongest predictors of job satisfaction

in US military personnel were perception of job pressure and

belief that the biggest problem in one’s life was the result of

job-related, rather than non-job-related, issues.

A key demand faced by military personnel is the number of

hours worked: military organisations require service to be

provided 24 hours per day, so days are divided into ‘‘shifts’’,

with different employees taking up posts throughout the day,

often involving working throughout the night. Shift work

increased stress in military police officers in Brazil (Franca

et al., 2011), while rotating shifts were related to poorer

turnover intentions (i.e. intention to leave the service), higher

levels of burnout, lower levels of job satisfaction and

commitment, and greater absenteeism in Dutch military

police (Demerouti et al., 2004). Greater number of weekly

hours worked was a predictor of suicide ideation in the US Air

Force (Langhinrichsen-Rohling et al., 2011).

Family issues/work-life balance

Due to the nature of the role, military personnel are often

away from their families for long periods, and the long hours

involved may lead to disruption at home. Several US studies

found that being away from family was a stressor (Bray et al.,

2010; Pflanz & Ogle, 2006) and predicted both turnover

intentions (Behnke et al., 2010) and psychological symptoms

(Carter-Visscher et al., 2010). Poor work-life balance signifi-

cantly predicted health symptoms and turnover intentions in

the Canadian military (Dupre & Day, 2007); stress in the US

military (Allen et al., 2011; Bray et al., 2010); turnover

intentions in US military law enforcement (Sachau et al.,

2012); and strain in the Royal Navy (Bridger et al., 2009).

Odle-Dusseau et al. (2013) found that poorer perception of the

work environment as family-supportive was associated with

psychological strain.

Other role-related factors

There were several other stressors identified which have been

categorised together as ‘‘other’’ work-related factors due to

the small number of studies that discussed their impact, and

the fact that they were not the primary focus of any study.

These stressors are: control/autonomy; physical work envir-

onment; and financial strain.

There was a small amount of literature relating to control;

lack of autonomy and control predicted strain in UK Navy

personnel (Bridger et al., 2011) and post-traumatic stress and

common mental disorders in the UK military (Fear et al.,

2009).

The physical work environment could also affect stress:

dissatisfaction with the physical conditions they had to work

under predicted stress and strain in both UK and US Navy

personnel (Bridger et al., 2011; Wilcove et al., 2009).

Finally, Allen et al. (2011) found a negative correlation

between stress and income in US Army families, though the

psychological sense of financial strain (i.e. worrying about

financial situation) was a stronger predictor of stress than

actual salary. A study of US Air Force personnel

(Langhinrichsen-Rohling et al., 2011) found that financial

stress predicted suicidal ideation in female personnel only.

Positive impact on wellbeing

Several factors were identified which were consistently

associated with a positive effect on wellbeing or job

performance. There was a small amount of literature

concerning fitness and exercise: the impact of stressors on

psychological wellbeing was mediated by physical fitness in

the US military (Dolan et al., 2005) and amount of time spent

on leisure-time physical activity in Brazilian Army personnel

(Martins & Lopes, 2013). Involvement in recreational

Table 2. Overview: factors affecting wellbeing.

Category Examples

Relationships with others: Leadership and Supervisory Support Support, feedback, leadership styleRelationships with others: Social Support and Cohesion Sense of belonging/camaraderie at work, relationships with colleagues/

family/friendsRelationships with others: Harassment and Discrimination Sexual harassment, perceived tokenismRole-related Stressors: Role Conflict Role clarity, role conflictRole-related Stressors: Commitment, Over-commitment and Effort-

Reward ImbalanceOver-commitment, effort-reward imbalance, feeling valued

Role-related Stressors: Work (Over)load and Job Demands Demands, resources, control, workload, long hours, shift workRole-related Stressors: Family Issues/Work-Life Balance Separation, concerns about family, demands at work/homeRole-related Stressors: Other Role-related Factors Control/autonomy, ability to participate in decision-making; physical work

environment; financial strainPositive Impact on Wellbeing Fitness, exercise, role identification, trust in the organisation

6 S. K. Brooks & N. Greenberg J Ment Health, Early Online: 1–11

activities mediated the relationship between work stress and

psychological distress in Australian Navy personnel

(McDougall & Drummond, 2010).

‘‘Army identification’’ was negatively associated with

depression and positively associated with job satisfaction

(Sani et al., 2012). Other personal or work-related values

which may moderate or mediate the effects of stressors

included possessing a strong ‘‘achievement’’ value (Britt

et al., 2004) and having trust in the organisation as a whole

(Redman et al., 2011).

It should also be noted that many of the factors identified

as stressors can also have a positive impact depending how

they are perceived. For example, while perceived poor or

lacking social support at work increased stress, perception of

support as good may increase job satisfaction and reduce

stress.

Discussion

This review highlights the importance of considering non-

deployment stressors in military personnel. Military organ-

isations should be able to improve the wellbeing of personnel

through addressing exposure to, and mediating the impact of,

non-deployment stressors.

Implications

Areas highlighted as worthy of attention are discussed below.

As many of the reviewed studies reported correlational

findings some caution must be taken before translating these

into practical implications. However, this review’s findings

provide useful insights into potential levers for intervention

which could be tested in future studies.

Relationships with others, particularly supervisors, were

particularly important to the psychological wellbeing and

occupational functioning of military personnel (Bridger et al.,

2007; Dupre & Day, 2007). This is interesting given that such

a profession is considered to be characterised more by

physical than socially-related risks. We suggest that super-

visors should be aware of the need to be supportive and give

directions and feedback clearly. Whilst military leadership

training for operational duties is well-developed, supervisors

may benefit from improved understanding about how best to

facilitate teams working on non-deployment tasks. Ensuring

that supervisors are trained in management as well as

leadership skills should be useful; for example, training to

encourage assigning well-defined roles for team members and

dealing with problems in a non-confrontational way. Evidence

suggests that employees thrive with clear, constructive

feedback from leaders (Mohd Bokti & Abu Talib, 2009),

and it should be investigated how to best provide this. For the

UK military, it may be that the current practice of twice-

yearly formal feedback from line managers is insufficient to

effectively inform employees of their performance and, if

necessary, how they can improve. Current appraisal methods

use a traditional top-down approach, where the manager is the

only evaluator. Assuming the manager is impartial and fair,

this can be useful in evaluating performance and setting goals;

however, the singular perspective means that bias from

managers could limit the potential for development. It may be

helpful to consider a more contemporary 360-degree

approach to appraisals, where employees are evaluated from

people in all areas within the organisation, providing a more

complete picture of how performance is being perceived. This

type of appraisal has been explored within civilian organisa-

tions with positive findings; employees reported that it

promoted reflection on what was going well and what could

be improved, and found it a positive learning experience

overall (Drew, 2009). Although 360 degree appraisals have

not been well-studied in military organisations, this is starting

to attract attention (Charbonneau & MacIntyre, 2011). Future

research may consider trialling both top-down and 360-degree

approaches to ascertain which method is most effective.

Cohesive units, good team functioning and peer support

were important (Mitchell et al., 2011, 2012). Future studies

should investigate how to build and maintain cohesion in units

even when not preparing for deployment. Group goals are

important in developing and maintaining cohesive units, and

leaders could influence this by establishing joint goals and

encouraging employees to work together. Many military

training courses aim to improve unit cohesion as a primary or

secondary objective (e.g. adventurous training), but few

training opportunities foster interpersonal skills. One excep-

tion to this is Trauma Risk Management (TRiM) training

(Greenberg et al., 2008), an intervention delivered by line

managers and aimed at improving the way personnel support

their colleagues following traumatic events. Although this

focuses on traumatic/operational stressors, TRiM may well be

useful at improving team relationships outside of the conflict

zone, and has been shown to effectively improve cohesion and

attitudes towards mental health in others in other organisa-

tions such as the police and railway employees (Sage et al.,

2016; Whybrow et al., 2015). Studies focusing on workplace

discrimination and harassment suggest that strategies to

reduce bullying and promote an equal opportunities climate

would be beneficial in terms of the wellbeing of employees.

Role clarity should also be considered as a possible target

for intervention as this impacted on wellbeing (Bridger et al.,

2007). Whilst it may not be practical to actually modify work

roles, it may be useful to provide personnel with information

focusing on role clarity such as ‘‘refresher’’ skills training

courses, and include providing role clarity as part of

leadership/management training. Role clarification interven-

tions have been used in the nursing sector with positive results

(Smith & Larew, 2013); these could be trialled in military

contexts to assess their impact. While it is appreciated that

organisations cannot necessarily reduce workloads, it may be

useful for personnel in particularly high-pressured roles to be

provided with ‘‘workload management’’ training focusing on

prioritising work, knowing when to delegate, and coping

strategies to mitigate the effects of a heavy workload.

Enabling employees to be involved in decision-making

processes, where possible, would also be helpful in terms of

giving them a sense of autonomy which appeared to be

associated with greater wellbeing. Weston (2010) outlines

strategies for enhancing autonomy in the nursing sector, such

as encouraging nurses to incorporate their knowledge and

expertise into clinical practice, encouraging continuous

reflection on the degree of autonomy involved in their

tasks, and coaching nurses in decision-making. Interventions

have provided mixed results in terms of actually enhancing

DOI: 10.1080/09638237.2016.1276536 Non-deployment predictors of wellbeing 7

autonomy (Schalk et al., 2010); further research is needed to

establish successful ways of improving autonomy. We do note

that as an authoritarian organisation, the ability of the military

to allow junior staff to be fully involved with decision making

may be limited.

Organisations may be regarded as having some duty of

care to the families of personnel; the review showed that

family concerns impact upon personnel’s wellbeing (Odle-

Dusseau et al., 2013). It might be possible to reduce work–

home interference by family-friendly working, e.g. flexible

working, where possible outside of deployment periods. For

example, it may be helpful to consider how personnel can

book annual leave when they want rather than as directed.

Leisure-time physical activity may mitigate the effects of

stress (Martins & Lopes, 2013). Agility and physical readi-

ness are obviously fundamental aspects of being in the

military or comparable occupations; nevertheless, our review

suggests that for some personnel additional physical fitness

training could be useful, especially if incorporated into their

everyday lives. Since unit cohesion and good relationships

with colleagues appeared to be protective while poor relations

with co-workers increased stress, we suggest it is important to

ensure that cutbacks in expenditure do not remove opportu-

nities for service sports teams and friendly matches or group

exercise routines. We further suggest that since military and

civilian personnel work together on joint projects within the

Ministry of Defence, there should be scope for whole teams,

not just uniformed teams, to recreate together to foster

cohesion.

These implications are particularly pertinent for those in

supervisory roles, who are in a position to improve many of

the aspects contributing to stress. These individuals should

actively build and maintain good relationships with subor-

dinates and use team-building activities to improve unit

cohesion; they can improve engagement by providing

encouragement and ensuring that their employees feel

pride in their work; and they can reward their personnel –

even if only in terms of positive feedback – to reduce any

imbalance between effort and reward and to ensure that

employees feel valued. Regular work-focused appraisals and

provision of feedback (formally and/or informally) with

employees may also improve role clarity. During these

discussions leaders should also enquire whether employees

have the necessary resources for the job; they could ask

personnel whether they felt supported by other unit members

and also about support networks outside of work to identify

those with poor support who might therefore benefit from

extra colleague support.

It is perhaps reassuring to note that many of the suggested

interventions are similar to those that the British military has

been using to develop and support operational capability for

many years. However, we suggest that there may be a need for

alteration of training styles and processes for use in support of

reducing the impact of non-deployment stressors.

Strengths

The main strengths of the review are the extensive list of

search terms, the searches of multiple databases, the rigorous

screening and data extraction processes and the use of a

quality appraisal tool allowing us to assess the quality of each

individual paper which was included.

A further strength was that we found our results fit well

with other existing models. For example, we found support for

the HSE’s (2007) six primary sources of work stress:

demands, control, support, negative workplace relationships

and role were all identified as key factors influencing the

wellbeing of military personnel. While the final source of

stress proposed by the HSE, change and whether employees

feel involved in organisational changes, was not discussed

explicitly in the literature, it could be argued that our findings

relating to autonomy and control are related to this. Future

research may consider exploring the relationship between

wellbeing and aspects of change in military personnel.

The review also provided support for several existing

models regarding stress at work: for example, the effort-

reward imbalance model (Siegrist, 1996) which suggests that

a lack of reciprocity between rewards (e.g. money, esteem,

career opportunities, positive feedback, feeling valued) and

effort at work can lead to negative emotions. A small amount

of the reviewed literature indicated that a lack of reciprocity

between rewards and effort appeared to lead to stress.

Findings also lent support to Karasek’s (1979) job decision

latitude model, which proposes that employees experience

adverse health consequences if their work makes high

demands while allowing little personal control, and the job

demands–control–support model (Johnson & Hall, 1988),

with a lack of reciprocity between demands and control also

being an important stressor.

Limitations

Studies came mainly from North America or Europe, perhaps

due to the choice to limit the search to English-language

papers; future reviews might consider translating foreign-

language papers. However, we did not limit the review to

certain countries and did include several papers from Asia and

Australia. It is important to note that there are fundamental

differences between military organisations of different

nations, and different political systems and circumstances in

different countries could impact on results. However, this

review highlights that in spite of the major differences,

personnel across the world appear to be affected by similar

non-deployment stressors in similar ways. Secondly, most

papers included were cross-sectional. More prospective and

longitudinal studies are needed to clarify the direction of

associations. Thirdly, as this review was exploratory in nature,

we have not explored the findings further than identifying

stressors; that is, we have not examined the interrelatedness of

the themes and how certain stressors may influence the

impact of other stressors. Future research could consider

building on existing models to tie together the various themes

found in this review. Fourth, we acknowledge that the review

would have benefited from having multiple reviewers assess

papers for inclusion: where there was uncertainty about

including papers, these were discussed with the second

author, but the majority of screening was performed by one

reviewer and so there is a possibility for bias. Fifth, though

our decision to limit the review to quantitative studies meant

that all findings presented here had been subject to statistical

8 S. K. Brooks & N. Greenberg J Ment Health, Early Online: 1–11

analysis and thus are more easily comparable, it may be useful

for future reviews to include qualitative studies. This may

support the findings presented here or identify additional

stressors. Finally, the meaning of concepts such as ‘‘stress’’

and ‘‘strain’’ were likely to vary between studies; this review

has used the terms as they were used in the individual articles.

Despite these limitations, this study remains a comprehensive

review of non-deployment stressors in the military.

Conclusions

While certain work-related aspects which may cause stress

cannot easily be changed (e.g. workload), the Armed Forces

can work with employees to ensure that they are supported,

their worries are listened to and they are taught mechanisms

to cope with their anxieties. Stressors such as lack of support

from leaders, poor cohesion and social conflict with col-

leagues, harassment at work and job-related issues such as

role conflict and work overload present a significant occupa-

tional health hazard in the routine military work environment.

In order to protect the wellbeing of personnel, the military

should aim to prioritise strengthening relationships between

employees and their supervisors/co-workers, and continue to

eliminate sources of job stress such as discrimination and

harassment in the workplace.

Declaration of interest

Financial support was received from the Headquarters Land

Forces (HQLF). NG runs a psychological health consultancy

which provides TRiM training amongst other services.

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Appendix I: Search strategy

Limits: full text, human, English language, 2003-13.Search 1; exp Military Personnel/or exp Military Psychology/or expMilitary Deployment/or exp Military Training/or military.mp.Armed force*.mpSpecial force*.mpSoldier*.mpService personnel.mp or exp service personnel/War.mp or combat experience/or combat/Troops.mpAir force*.mp or air force personnel/Army.mp or army personnel/Naval personnel.mp or naval personnel/Combine all with ORSearch 2; Non-operational stress*.mp or non operational stress.mpWorkplace stress*.mp or job stress/Work-place stress*.mpOccupat* stress*.mp or occupational stress/Burnout.mpJob strain*.mp or occupational strain*.mpWork* function*.mp or job performance/Occupational function*.mp

Team performance.mpOrganisational outcome*.mp or organizational outcome*.mpMental health.mp or mental health/Wellbeing.mp or well-being.mpAnxiety.mp or anxiety/Stress.mp not post-traumatic not posttraumatic not PTSDWork performance.mpCombine all with ORSearch 1 AND Search 2(Further search for other occupational populations not included in thispaper)Search 3; High risk work* or high risk job* or high risk occupation*Police.mp or police personnel/Aid agencies or aid agencyHumanitarian aidRelief workEmergency reliefRescue services or rescue workers/Firefighter*.mp or fire fighters/Law enforcement.mp or law enforcement/Emergency response

10 S. K. Brooks & N. Greenberg J Ment Health, Early Online: 1–11

Hazardous work* or hazardous occupation*Disaster recoveryConstruction work.mpCombine all with ORSearch 2 AND Search 3

Appendix II: Quality appraisal

Section 1: Study design

(1) The research question is clearly stated

(2) The sample size is described.

(3) The sampling method is described.

(4) The inclusion criteria are described.

Section 2: Data collection and methodology

(1) Standardised tools are used, or where measures are

designed for the study, attempts to ensure reliability and

validity have been made.

(2) Number of participants is described at each stage of the

study.

(3) Reasons for loss to follow-up are described.

(4) Data on non-participants is provided.

Section 3: Analysis and interpretation of results

(1) Details of statistical tests and confidence intervals where

appropriate are described.

(2) The answer to the study question is given.

(3) Conclusions follow from the data reported.

(4) Conclusions are accompanied by the appropriate caveats.

All questions answered with YES or NO with the exception of

‘‘Reasons for loss to follow-up are described’’ which was

answered with NA if the study took place at only one time-

point. In these cases, the percentage was calculated as a sum

of 11 responses rather than 12. All items were given equal

weight when determining the final score.

Appendix III: Flow diagram of search and screeningprocess

Records iden�fied through database searching

(n = 8290 )

Addi�onal records iden�fied through other sources

(n = 5 )

Records a�er duplicates removed (n = 6667 )

Titles screened (n = 6667 )

Records excluded (n = 5186 )

Full-text ar�cles excluded (n = 370 )

Abstracts screened (n = 1481 )

Records excluded (n = 1061 )

Full-text ar�cles assessed for eligibility

(n = 420 )

Studies included in qualita�ve synthesis

(n = 50 )

DOI: 10.1080/09638237.2016.1276536 Non-deployment predictors of wellbeing 11